Newsletter

Sports

Body

Conditions & Symptoms

Treatments

RSS feed

Syndicate content

Hip overuse then turning into an imbalance problem

Question: Hip overuse then turning into an imbalance problem

SORRY THIS IS GOING TO BE LONG!

I am not an athlete by known defination of the word, yet my two jobs require me to walk, pivot, twist, lift, and squat. In March '09 I got a hostess job which turned me into a bus girl during rush time, clearing off 200+ tables in 4 hours. I did not have alot a pain then but when I switched to a waitress job in June the pain started. My pain started out as feeling pain on the outside of my right hip that ran down to the knee (along the side and underneath). I intitially thought it was an iliotibial band overuse problem yet after a few weeks I decided to get a PCP's view on this. He diagnosed it as trochantic hip burstitis and gave me a cortisone inject, it flared, and the pain had intensified 4X within 3 days. Within this time frame I also developed a pain in my butt so bad I couldn't bearly stand sitting on the toilet rim. It was left unaddressed for about a month, due other health problems that arose, and the pain eventually krept up into my right lower back (creating sciatica) and then went to the ER for a severe right stomach and side ache. The ER doctor ruled out any organ problem and suggest it might be musclular or skeletor. The pain in my side latest for over a week and then settle down to a low roar but my right abs were and still are slightly swollen over the rib cage. A few weeks later I went in to get a lumber MRI done and everything was okay except for a posturer annual tear with a small midline hernation on L5-S1, so no sciatic nerve pinch.

Its been about four months now and no real relief from this right hip and side pain. I lost my second job as a waitress so now I am on a 26 to 30 hours work schedule at my local small town grocery store. I got second opinion on the MRI results from another PCP and he referred me to a Ortho, specialized in back, to be sure the L5-S1 herniation was absolutely not the problem. The Othro took additional back xrays and read over the MRI and said I did not have a back problem. He examined my strength and motion and also diagnosed it as trochantic burstitis. He gave me another cortizone injection and after a weeks work of intensely burning butt muscles the hip, buttock and thigh pain went away BUT then the front of my hip started hurting and now also my hamstring (both areas were not painful before).

I went to a Phyical Therapist after enduring 8 months since the onset of right hip pain. She did some strength testing on both hips and though my right clearly has burstitis, tendonistis, and muscle strains it was much stronger then my left side. She said I had a real bad case of imbalance. She tested my strength of my hip muscles that hold the hip from rotating outwards from midline (sitting on the edge of the workout bench, legs hanging over and pushing the knees away from each other). My left hip could not hold her slight pushing. She suspected something so she had me do some easy gluteus medius and minimus gravity exercises and then retested the knees away from each other strength test... This time I could hold it better. She THINKS maybe there is something wrong with the left hip, she through out a hip dislocation - which I can not see how since I have never fell, ran into anything, or etc.

So I am at a loss in how to see what is wrong... do I find a new Ortho specialized in sport injuries over keeping the back Ortho? And should I demand hip imaginery of both sides, since no doctor along this journey has done any to rule out something more serious? I just do not if trochantic burstitis causes this much of a problem or not. I do not want to make a big deal out it if it in not a big deal. Any help or advice would be greatly appreciated !!!!

Answer:

I should mention that I always have worked out and pretty limbar still. As a young adult I was in TaeKwonDo, then married a farmer and did animal chores for 6 hours a day. I raised coonhounds for nearly 20 years and go out a few night per week walking the woods as the hounds worked their noses. Why am I have this now... when I have done more activity then what I do now. I am 41 years old, weight 105 lbs, and stand 5' 5" tall --- so I am not over weight.

Answer:

You might be suffering from a tight restricted asymmetric psoas muscle, unfortunately when one muscle is dysfunction other muscle are or add to the dysfunction. Isolated muscle dysfunction most time never happens only in cases of trauma to a specific muscle even then muscle dominance can develop. None the less in the case of repetitive motion, poor posture, poor mechanics, and over use one isolated muscle is never the only muscle of concern. These dysfunctions are the cause of poor alignment of the pelvic. In the case of the main flexor muscle (the psoas) when this muscle becomes tight and restricted it can cause the pelvic to tilt forward, create an excessive cure of the lower back causing low back pain and possible herniation. Because of its attachment to the femur it can irritate the bursa that lies between the femur and the muscle (causing bursitis). And because the sciatic nerve runs through the psoas muscle it can smother the never by pressing it to bone causing pain in the in the buttock down the back of the leg. This distortion and misalignment of the pelvic can be unilateral or bilateral; in your case it may be unilateral (on your right side). This condition is sometimes known as Lower crossed syndrome. Referred pain patterns are felt in the areas you’ve been mentioned. Pain can be felt in the stomach and groin area as well. This condition also causes other muscles to become weak.

Your psoas muscles are found in front (or inside) the pelvic bone on both side of your pelvic. It attaches itself to the trochanter (over lay a bursa), it also attaches itself to the anterior portion of the pelvic bone (where the sciatic never runs through, and finally it attaches to the lower spine L1-L5 and then the 12 and 11 rib.

My assessment is only made from the information that I've read it is not a complete and full assessment. To get a full and complete assessment I recommend that you look for a massage therapist in your area specializing in deep sports/orthopedic massage or train in ART (Active Release Techniques or Myo Skeletal Alignment Techniques®

I wish you well in your pursuit to wellness.

Ray Mingo

Answer:

Hi kelkay,
again its quite hard to make a definite diagnosis from your description. however you say "pain started on the outside of Right hip to the Knee"

my first question is "are you right or left handed" as in do you carry plates etc in right hand or left. this makes a huge difference to posture and forces through the body.

Listening carefully to what you say, i feel it is probably a Right sided facet joint problem, that is the small joints that lock the vertebra together. if these become inflamed due to stress or strain, they can affect the nerves passing close to them. thus giving you symptoms that vary from front to back of thigh etc. Small inflammations don't show up as a significant protrusion on MRI scans, leading to back Docs discounting them as nothing unusual.
injections have discounted bursitis. And even though you seem stronger on your right side compared to left, i believe this is due to a strong Left pelvis/buttocks allowing the Right side to preform well. Alternatively a Weak right buttocks will correspond to a weak Left side on testing. A good physiotherapist should be able to differentiate between levels affected and inflammation through touch. I think that some treatment to the Right sided lower back from L1-L5 level, along with soft tissue release to R hip, will decrease any restriction built up due to pain behaviours.
Although it seems complicated, you need to go back initially to cause of pain, find mechanism that caused it and work forward. i think you will find that most problems change due to pain patterns causing posture to change etc.
i feel for you, as it is very frustrating going to several supposed experts and coming away with no more solutions.
My advice is go to
- experienced manual physical therapist specialising in lumbar Spine problems, as they see the broader picture.
The most important thing is someone who will give you time to tell your full story, and work with you to full health.

To discount a few things said already, ray has assumed you have a Right psoas problem... maybe you do. if indeed a tight psoas muscles cause the pelvis to tilt forward, then surely it would cause impaction of the lumbar facets rather than a possible lumbar disc protrusion.
Also the sciatic nerve does not pass through the psoas muscle..in fact it passes through the muscles that coat the back of the hip, possibly the piriformis muscle, in 15% of people or so. Or along side the glut muscles, heading down the back of your leg, not the front.

Regards